Hypertension

Question 1

Essential/primary hbp =

Answer 1

no underlying cause (90% of cases)

Question 2

2ndry hbp =

Answer 2

has an underlying cause

Question 3

In diabetes ___ complications of hyperglycaemia occur before ____

Answer 3

macrovascular before microvascular

Question 4

Diagnosis of a metabolic disorder, more/=3 of the following:

Answer 4

abdominal obesity, high tris, low HDL-C, hbp and high fasting glucose

Question 5

Complications of hypertension =

Answer 5

HF, cerebral haem, atheroma, renal failure, sudden cardiac death

Question 6

NO and prostaglandins =

Answer 6

vasodilators

Question 7

catecholamines and angiotensin 2 =

Answer 7

vasoconstrictors

Question 8

increased protein intake causes renal blood flow to ___ > ___bp

Answer 8

increase renal flow

decreases bp

Question 9

2ndry hypertension due to renal failure is almost always ___

Answer 9

salt sensitive

Question 10

Causes of 2ndry hypertension

Answer 10

renal disease - glomerulo/pyelonephritis, cysts
endocrine - adrenal hyperplasia - Conn’s; Phaeochromocytoma
artery stenosis/coarctation of aorta
drugs eg. steroids

Question 11

Phaeochromocytoma =

Answer 11

tumour of the adrenal medulla releases excess noradrenaline

increases TPR and CO

Question 12

Conn’s syndrome =

Answer 12

excess aldosterone independent of RAAS

Question 13

Cushing’s = excess ___

Answer 13

glucocorticoids

Question 14

Benign hypertension definition =

Answer 14

asymptomatic and picked up incidentally

still life-threatening

Question 15

Malignant hypertension definition =

Answer 15

accelerated hypertension - increase occurs over a short time - life threatening
Diastolic >130-140

Question 16

Malignant hypertension can lead to -

Answer 16

cerebral oedema (seen as papilloedema), acute renal/HF
headache and cerebral haem
fibrinoid necrosis of vessels ie. blown apart

Question 17

Benign hypertension can lead to -

Answer 17

LV concentric hypertrophy => sudden death by low perfusion or arrhythmia
CCF
atheroma
stroke
renal disease
aneurysm rupture

Question 18

CV mortality risk x2 with every __ increase in sbp and ___ increase in dbp

Answer 18

20 in sbp

10 in dbp

Question 19

Offer ____ if clinic bp is >140/90

Answer 19

ABPM

Question 20

ABPM =

Answer 20

more/=2 bp measurements/hr during waking hrs - roughly 14/day
automatic

Question 21

HBPM =

Answer 21

2 seated bp measurements 1 min apart, record x2/day for 4-7 days
discard 1st days and average the rest
self measured

Question 22

Stage 1 hypertension =

Answer 22

clinically >=140/90 and A/HBPM >=135/85

Question 23

Stage 2 hypertension =

Answer 23

clinically >=160/100 and A/HBPM >=150/95

Question 24

Severe hypertension =

Answer 24

> =180 clinically or dbp clinically >=110

Question 25

Screening tests offered to anyone with hypertension

Answer 25

urine test - for protein
bloods - for glucose, electrolytes, creatinine, estimated glomerular filtration rate, chol.
Fundi - for hypertensive retinopathy
12-lead ECG

Question 26

Grade 1 hypertensive retinopathy

Answer 26

slight/mod narrowing of retinal arteries
AND
arterovenous ratio >=1:2

Question 27

Grade 2 hypertensive retinopathy

Answer 27

mod/severe retinal artery narrowing
AND
arterovenous ratio

Question 28

Grade 3 hypertensive retinopathy

Answer 28

bilateral soft exudates (cotton wool spots)/flame-shaped haems

Question 29

Grade 4 hypertensive retinopathy

Answer 29

bilateral optic nerve oedema = blurred disc - papilloedema
AND
hard (yellowish) exudates

Question 30

hbp in afro-caribbean/black don’t give __

Answer 30

ACEI/ARB first-line

Question 31

For those under 55 and Caucasian hbp stepwise treatment =

Answer 31

ACEI/ARB
>+CCB
>+thiazide
>+another diuretic/α/β-blocker + expert advice

Question 32

If >55yo or black with hbp stepwise treatment =

Answer 32

CCB
>+ACEI/ARB
>+thiazide
>+another diuretic/α/β-blocker+expert advice

Question 33

Fibromuscular dysplasia

Answer 33

Corkscrew in renal/cerebral artery

Commonest in young females, treatable cause of hypertension

Question 34

Causes widespread tumours and can cause phaeochromocytoma =

Answer 34

VHL - Von Hippel Lindau

defect in p53

Question 35

Truely resistant hypertension is only diagnosed if ___

Answer 35

don’t respond to spironolactone

Question 36

Spironolactone causes an increase in ___ must be monitored

Be cautious of use in patients with __/___

Answer 36

creatinine and K+

diabetes/slow GFR

Question 37

Podagra =

Answer 37

gout that involves joint at base of big toe

Question 38

Gout is a type of ____
Present with ____ joint
Due to ____

Answer 38

arthritis
red, hot, painful, tender, swollen joint
uric acid excess crystallises and coolness precipitaes it into the blood

Question 39

___—____—->uric acid

Answer 39

xanthine oxidase converts xanthine to uric acid

Question 40

_____ (drugs) can cause gout as cause ___ not to be excreted as well

Answer 40

thiazide diuretics

uric acid

Question 41

xanthine oxide inhibitors used to treat gout =

Answer 41

allopurinol, oxypurinol and phytic acid

Question 42

___ competes with uric acid at distal tubule and decreases its excretion

Answer 42

aspirin (worsens gout)

Question 43

____ can cause hbp by stopping production of prostaglandins and blocking NA+ excretion

Answer 43

Ibuprofen (NSAIDS)

Question 44

bp lowering drug used in pregnancy

Answer 44

methyldopa
labetalol
nifedipine
hydralazine (only if severe/ after 37wks as may cause neonatal thrombocytopaenia)

Question 45

If v high systolic bp but low/normal diastolic suspect

Answer 45

aortic regurgitation
OR
stiff arteries